Bullying and psychotic symptoms in youth with bipolar disorder.

BACKGROUND: Childhood trauma is associated with psychosis in adults with bipolar disorder (BD). Although bullying represents a widespread form of childhood trauma, no studies thus far have investigated the association of bullying and psychosis in pediatric bipolar disorder (PBD). We aim to examine the association between psychosis in PBD with bullying victimization. METHODS: We included 64 children and adolescents (age± mean= 12±3.43) outpatients with BD spectrum disorders. Psychiatric diagnoses were assessed with the semi- structured interview Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime (KSADS-PL) version with additional depression and manic symptom items derived from the Washington University in St. Louis Kiddie Schedule for Affective Disorders (WASH-U-KSADS). Bullying, demographic, and clinical variables were assessed during the clinical interview. RESULTS: A lifetime history of psychotic symptoms was associated with bullying (p = 0.002), suicidal behavior (p = 0.006), low socioeconomic status (p = 0.04), and severity of PBD (p = 0.02). Only bullying (OR = 7.3; 95%CI = 2-32) and suicidal behavior (OR = 7.6; 95%CI = 1.5-47.8) remained significant after adjustment for confounders. In a supplementary analysis, we developed a model using supervised machine learning to identify the most relevant variables that differentiated participants with psychotic symptoms, which included bullying, Clinical Global Impression-Severity scale (CGI-S), and suicidal behavior (accuracy = 75%, [p = 0.03]; sensitivity = 77.91%; specificity = 69.05%; area under the curve [AUC] = 0.86). LIMITATIONS: Small sample, cross-sectional design, and generalizability of findings beyond the outpatient clinical sample. CONCLUSIONS: Findings underscore the importance of assessing bullying in PBD participants. Future longitudinal studies with larger samples are needed to replicate our findings and determine causality.

Lower estimated intelligence quotient is associated with suicide attempts in pediatric bipolar disorder.

BACKGROUND: Approximately 20% of individual with pediatric bipolar disorder (PBD) have a lifetime history of suicide attempt. Some cognitive measures were associated with a suicide attempt, but no study has assessed the association of this event with the estimated intelligence quotient (IQ) in PBI. In adult Bipolar Disorder no association between IQ and suicidality was found, with different correlations between cognitive measures. There are studies in general population showing a negative correlation and others did not find any association. In Schizophrenia, IQ had a positive correlation with suicide attempt. So, the correlation between IQ and suicidality still controversial. METHODS: We recruited 63 children and adolescents younger than 18 years of age with PBD based on DSM-IV criteria from an outpatient clinic in Brazil. Manic and depressive symptoms were assessed with the YMRS and CDRS, respectively. Estimated IQ was assessed with the WISC-III. The presence or absense of suicidal attempt, clinical and demographic variables were assessed with the K-SADS-PL-W. RESULTS: Patients who attempted suicide had lower estimated IQ compared to patients who did not attempt suicide (82.72 ±â€¯18.70 vs. 101.0 ±â€¯14.36; p = 0.009). This finding remained after correction for depressive symptoms and family income (OR = 0.94; 95% CI = 0.89 - 0.99; p = 0.029). LIMITATIONS: Small sample, reverse causality could not be discarded, we only used two subscales of the WISC-III to estimate intelligence. CONCLUSION: Estimated IQ and suicide attempts were negative correlated in PBD. Future longitudinal and larger studies may confirm our findings.

[Reliability of neurological assessment scales in patients with stroke]. / Confiabilidade de escalas de comprometimento neurológico em pacientes com acidente vascular cerebral.

Scales for the assessment of neurological impairment are employed in clinical trials, outcome evaluation and in therapeutic decisions. We evaluated the reliability of the Portuguese version of the Rankin Scale (RS), Barthel Index (BI) and the NIHSS (National Institute of Health Stroke Scale) in 51 stroke patients, estimating the agreement of the results for examiners. The interrater reliability was measured using the Kappa Coefficient and Intraclass Correlation Coefficient. The RS showed moderate, substantial and excellent coefficients of agreement. The BI showed from substantial to excellent coefficients of agreement as a whole and also for its constituents. This scale was stratified in prognostic and functional groups, both presenting coefficients of agreement from substantial to excellent. The NIHSS presented excellent agreement on its total and substantial agreements on its individual items. The NIHSS was also stratified in groups of points, which presented moderate or excellent coefficient, and in groups of congruous items, wich showed a moderate to excellent agreement. These results suggest that the Portuguese version of the RS, BI and the NIHSS present adequate reliability.

Confiabilidade de escalas de comprometimento neurológico em pacientes com acidente vascular cerebral / Reliability of neurological assessment scales in patients with stroke / Reliability of neurological assessment scales in patients with stroke

Escalas de comprometimento neurológico são utilizadas na avaliação de novos tratamentos, no acompanhamento da evolução clínica e em decisões terapêuticas. Estudamos a confiabilidade de três escalas: a Escala de Rankin (ER), o índice de Barthel (IB) e a National Institute of Health Stroke Scale (NIHSS) versadas em português, em 51 indivíduos com acidente vascular cerebral, estimando a concordância entre resultados de diferentes examinadores. Utilizamos os coeficientes de concordância Kappa e Coeficiente de Correlação Intraclasse. A ER teve coeficientes moderados, substanciais ou excelentes. No IB estes foram substanciais ou excelentes nos totais e nos itens, assim como quando foi estratificado em agrupamentos prognósticos e funcionais. A NIHSS apresentou coeficientes excelentes nos totais, substanciais nos itens e moderados e excelentes nas estratificações em grupos de pontos e de itens afins. Estes resultados indicam que as versões em português da ER, o IB e a NIHSS apresentam adequada confiabilidade.

Scales for the assessment of neurological impairment are employed in clinical trials, outcome evaluation and in therapeutic decisions. We evaluated the reliability of the Portuguese version of the Rankin Scale (RS), Barthel Index (BI) and the NIHSS (National Institute of Health Stroke Scale) in 51 stroke patients, estimating the agreement of the results for examiners. The interrater reliability was measured using the Kappa Coefficient and Intraclass Correlation Coefficient. The RS showed moderate, substantial and excellent coefficients of agreement. The BI showed from substantial to excellent coefficients of agreement as a whole and also for its constituents. This scale was stratified in prognostic and functional groups, both presenting coefficients of agreement from substantial to excellent. The NIHSS presented excellent agreement on its total and substantial agreements on its individual items. The NIHSS was also stratified in groups of points, which presented moderate or excellent coefficient, and in groups of congruous items, wich showed a moderate to excellent agreement. These results suggest that the Portuguese version of the RS, BI and the NIHSS present adequate reliability.

Oxigenoterapia / Oxygen therapy

Os autores, com o presente trabalho, abordam diversos aspectos da oxigenioterapia, como técnica de administraçao de oxigênio complementar, complicaçoes potenciais, fluxo de oxigênio ofertado.

Sífilis congênita / Congenital syphilis

Os autores apresentam um caso de sífilis congênita, que ganha relevo pelo seu alto índice de transmissibilidade materno-fetal e por ser causa de morte fetal e perinatal (cerca de 40 por cento dos lactentes infectados). Pela importância do tema, sao apresentados, ainda, revisao bibliográfica que aborda os sinais e sintomas, métodos diagnósticos, tratamento, e aspectos anatomopatológicos.

Síndrome de Kartagener / Kartagener's syndrome

A síndrome de Kartagener consiste em uma tríade de sintomas, determinada geneticamente, afetando a atividade de proteínas importantes ao movimento ciliar, sobretudo no trato respiratório e espermatozóides. Trata-se de uma patologia pouco comum, responsável pelo aumento na sucetibilidade dos pacientes às infecçoes respiratórias. Os autores apresentam um relato de caso, em paciente pediátrico, e fazem uma breve revisao bibliográfica, dando ênfase aos aspectos anatomopatológicos da doença.